ABSTRACT
PURPOSE: The expression of matrix metalloproteinase-2 (MMP- 2) by cancer cells has been implicated in metastasis through cancer cell invasion of the basement membranes mediated by a degradation of collagen IV. However, the MMP-2 proenzyme requires proteolytic activation for its physiologic or pathologic role. We tried to 1) compare expression and activation of MMP-2 in breast cancers with benign tumors, 2) determine the correlation between the actviation of MMP-2 in breast cancer and established prognostic factors, 3) observe whether MMP-2 is expressed and activated in axillary lymph nodes as well, and 4) determine the degree of correlation between MMP-2 activity in lymph nodes and metastatic status, if MMP-2 is expressed in lymph node. METHODS: The specimens came from 11 fibroadenomas, 32 invasive ductal carcinoma and 129 axillary lymph nodes from cancer cases. Pro-MMP-2 cDNA transfected MDA-MB-231 cells were cultured and the conditioned media from them was used for a control. Zymography was used to monitor MMP-2 activation through the detection of the inactive proenzyme form (72 kDa) and the active form (62 kDa). Immunohistochemical staining was also performed for the localization of MMP-2 expression in tissues. RESULTS: 1) 72 kDa was expressed in all fibroadenomas and cancers, while 62 kDa was expressed in only 10 cases of fibroadenomas and all cancers. MMP-2 activity (62 kDa/72 kDa +62 kDa) was significantly higher in cancers than in fibroadenomas (P=0.014). 2) MMP-2 activity in cancers was significantly correlated with nodal metastasis (P=0.040). 3) The expression of MMP-2 in lymph nodes was very low and MMP-2 activity was not correlated with metastatic status. However, the immunohistochemical staining showed different staining patterns between the metastatic and non-metastatic nodes. CONCLUSION: We suggest that a measurement of the activation of MMP-2 could be useful as a prognostic marker representing metastatic potential in breast cancer. However, the low expression of MMP-2 in lymph nodes is an interesting subject for further study.
Subject(s)
Basement Membrane , Breast Neoplasms , Breast , Carcinoma, Ductal , Collagen , Culture Media, Conditioned , DNA, Complementary , Fibroadenoma , Lymph Nodes , Matrix Metalloproteinase 2 , Neoplasm MetastasisABSTRACT
PURPOSE: The expression of matrix metalloproteinase-2 (MMP- 2) by cancer cells has been implicated in metastasis through cancer cell invasion of the basement membranes mediated by a degradation of collagen IV. However, the MMP-2 proenzyme requires proteolytic activation for its physiologic or pathologic role. We tried to 1) compare expression and activation of MMP-2 in breast cancers with benign tumors, 2) determine the correlation between the actviation of MMP-2 in breast cancer and established prognostic factors, 3) observe whether MMP-2 is expressed and activated in axillary lymph nodes as well, and 4) determine the degree of correlation between MMP-2 activity in lymph nodes and metastatic status, if MMP-2 is expressed in lymph node. METHODS: The specimens came from 11 fibroadenomas, 32 invasive ductal carcinoma and 129 axillary lymph nodes from cancer cases. Pro-MMP-2 cDNA transfected MDA-MB-231 cells were cultured and the conditioned media from them was used for a control. Zymography was used to monitor MMP-2 activation through the detection of the inactive proenzyme form (72 kDa) and the active form (62 kDa). Immunohistochemical staining was also performed for the localization of MMP-2 expression in tissues. RESULTS: 1) 72 kDa was expressed in all fibroadenomas and cancers, while 62 kDa was expressed in only 10 cases of fibroadenomas and all cancers. MMP-2 activity (62 kDa/72 kDa +62 kDa) was significantly higher in cancers than in fibroadenomas (P=0.014). 2) MMP-2 activity in cancers was significantly correlated with nodal metastasis (P=0.040). 3) The expression of MMP-2 in lymph nodes was very low and MMP-2 activity was not correlated with metastatic status. However, the immunohistochemical staining showed different staining patterns between the metastatic and non-metastatic nodes. CONCLUSION: We suggest that a measurement of the activation of MMP-2 could be useful as a prognostic marker representing metastatic potential in breast cancer. However, the low expression of MMP-2 in lymph nodes is an interesting subject for further study.
Subject(s)
Basement Membrane , Breast Neoplasms , Breast , Carcinoma, Ductal , Collagen , Culture Media, Conditioned , DNA, Complementary , Fibroadenoma , Lymph Nodes , Matrix Metalloproteinase 2 , Neoplasm MetastasisABSTRACT
PURPOSE: This study evaluates the effectiveness of nonoperative management of blunt hepatic and splenic injuries and the efficiency of follow-up. METHODS: The medical records of 49 patients with blunt hepatic and splenic injuries from January 1, 1993, to November 30, 1999, were reviewed. There were 35 patients with hepatic injuries and 14 patients with splenic injuries. The patients were divided into two groups, early and late, according to the year of injury. The severities of the injuries were determined by using the organ injury scale (OIS). We analyzed radiological findings and clinical parameters, including the cause of injury, combined injuries, symptoms, vital signs, amount of transfusion, reason for operation, operative findings, length of hospital stay, and complications. The results of treatment and follow-up were evaluated. RESULTS: Of the 49 patients, 34 patients (69.4%) were treated nonoperatively. There were no mortalities and treatment failures in patients with nonoperative treatment. Indications of operation during nonoperative treatment were hemodynamic instability and signs of aggravated peritoneal irritation. Major hepatic venous injury was suggestive of hemodynamic instability. There was a significant difference between patients with nonoperative management and those with operative management in transfusion requirements (1.2 units vs. 12.1 units, p<0.05). The rate of nonoperative management increased from 50.0% (12/24) in the early group to 88.0% (22/25) in the late group, and nontherapeutic operation decreased from 16.7% (2/12) in the early group to 0% (0/3) in the late group. All 34 patients with nonoperative management took CT scans as a follow-up. In patients with grade I or II on the OIS, the lesions had nearly disappeared at 2 weeks after injury. However, in patients with grade III or higher, resolusion of the lesion was minimal. A hepatic cyst developed in one patient with grade IV and a splenic cyst developed in another. CONCLUSION: Hemodynamic stability and findings on serial physical examinations are significant criteria for nonoperative management of blunt hepatic and splenic injuries. In patients with grade I or II injuries on the OIS, a follow-up CT is not necessary. In patients with grade III or higher, it is more efficient to delay a follow-up CT until 3 weeks or later after the injury if there are no symptom suggesting complications.
Subject(s)
Humans , Follow-Up Studies , Hemodynamics , Length of Stay , Liver , Medical Records , Mortality , Physical Examination , Spleen , Tomography, X-Ray Computed , Treatment Failure , Vital SignsABSTRACT
PURPOSE: The clinical influences of mucinous colorectal carcinomas are still controversial. Some previous reports have suggested that mucinous carcinomas of colorectum affect more young patients, involve the more proximal colon, are more advanced at diagnosis, show increased incidence of local and distant metastasis, and have a worse prognosis than adenocarcinoma. We evaluated the clinicopathological aspect of mucinous colorectal carcinoma. METHODS: A retrospective review of colorectal cancer patients treated between January 1990 and December 1998 was undertaken. Eight-hundred-fifty patients were operated for colorectal cancer during the period, among them seven- hundred-eighty-two patient records were available for this study. Sixty-two patients (7%) could be classified as mucinous carcinoma as defined by more than 50% of mucin- secreting pattern on histological examination. The age and sex distribution, primary location of tumor, modified Dukes' classification at diagnosis, recurrence rates and 5-year survival of mucinous carcinoma patients were compared with those of adenocarcinoma patients. Survival was calculated according to Kaplan-Meyer, and the differences were compared using the log-rank test. RESULTS: The sex ratio of mucinous carcinoma was 2.05: 1, whereas 1.32: 1 in adenocarcinoma. The age distribution of mucinous carcinoma showed orderly 60s (30.7%), 50s (17.7%), 40s (17.7%) similar to adenocarcinoma. The sites of the mucinous carcinoma were 22 (35.5%) in the rectum, 21 (33.9%) in the right colon, 6 (9.7%) in the transverse colon, whereas for adenocarcinoma 250 (37.0%) in the rectum, 137 (20.3%) in the sigmoid colon, 114 (16.9%) in the ascending colon. The stage of primary tumor at diagnosis was as follows: In mucinous carcinoma, 5 stage B1 (8.1%), 13 B2 (21.0%), 33 C2 (53.2%), 11 D (17.7%). In adenocarcinoma, 20 stage A (3.0%), 61 B1 (9.0%), 210 B2 (31.1%), 15 C1 (2.2%), 250 C2 (37.0%), 120 D (17.7%). Three-year and five-year disease free survival rates were similar, but slightly higher in patients with adenocarcinomas. Mean survival time was also similar, 45.5+/-38.1 months in the mucinous carcinoma group and 45.6+/-33.4 months in the adenocarcinoma. Five-year survival was 65.6% and 68.1% in patients with mucinous carcinomas and adenocarcinomas, respectively; but the difference was not statistically significant. The recurrence rates were 41.9% and 22.3% in patients with mucinous carcinoma and adenocarcinoma, respectively with statistical significance (P<0.005). Local recurrence was more frequent in the mucinous carcinoma than in the adenocarcinoma significantly. CONCLUSIONS: Our study suggested that mucinous colorectal carcinoma showed decreased survival, although having no statistical significance and increased recurrence rates with statistical significance compared with those of adenocarcinoma. So, we recommend aggresive surgical treatment and careful follow-up in mucinous colorectal carcinoma.
Subject(s)
Humans , Adenocarcinoma , Adenocarcinoma, Mucinous , Age Distribution , Classification , Colon , Colon, Ascending , Colon, Sigmoid , Colon, Transverse , Colorectal Neoplasms , Diagnosis , Disease-Free Survival , Follow-Up Studies , Incidence , Mucins , Neoplasm Metastasis , Prognosis , Rectum , Recurrence , Retrospective Studies , Sex Distribution , Sex Ratio , Survival RateABSTRACT
Childhood intussusception is usually idiopathic, and pathological lesions as the leading point are found in limited cases. Sixteen operative cases with leadpoints among 2,889 cases of childhood intussusecption treated at the surgical departments of the affiliated hospitals of Catholic University over 19 years are reviewed. The approximate incidence of pathological lesions as the leading point was 0.6%. The male to female ratio was 2:1. The mean age was 3.5 years. There was not an age preponderance. The symptoms were vomiting (63%), abdominal pain (38%), irritability (38%), bloody stools (25%), fever (25%) and abdominal mass (6%). The average duration of the symptoms was 2.4 days (1-10days). The most common lesion was Meckel's diverticulum, followed by malignant lymphomas, polyps, ectopic pancreas, and cecal duplication. An ileocolic type was most frequent, followed by ileoileocolic and ileoileal. Segmental resection or wedge resection of the ileum was done in 10 cases, ileocecectomy in 3, and right hemicolectomy in 3. Surgical reduction was done only in an ectopic pancreas, with no later recurrence. The average hospital stay was 10 days. Postoperative adhesive ileus occurred in two cases, and in one of them adhesiolysis was performed. One case of malignant lymphoma died at 28 days after surgery due to chemotherapy related complication.
Subject(s)
Female , Humans , Male , Abdominal Pain , Adhesives , Drug Therapy , Fever , Ileum , Ileus , Incidence , Intussusception , Length of Stay , Lymphoma , Meckel Diverticulum , Pancreas , Polyps , Recurrence , VomitingABSTRACT
BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.
Subject(s)
Female , Humans , Male , Middle Aged , Chest Pain , Contrast Media , Early Diagnosis , Empyema , Empyema, Pleural , Esophagectomy , Esophagostomy , Esophagus , Gastrostomy , Internal Medicine , Jejunostomy , Korea , Ligation , Mediastinitis , Mortality , Pneumonia , Prognosis , Retrospective Studies , Rupture , Rupture, Spontaneous , Subcutaneous Emphysema , Sutures , Thorax , Tomography, X-Ray Computed , VomitingABSTRACT
No abstract available.